High risk Human papillomaviruses (HR-HPVs) are recognized as the most common STIs worldwide. There are at least 15 genetically distinct HR-HPVs, which account for approximately 95 percent of cervical cancers, The distribution of HR-HPVs varies by country, which has an impact on the development of effective screening, clinical interventions, and vaccine strategies. This is especially true in low- and middle-income countries (LMIC) like Tanzania. Sub-Saharan African countries like Tanzania have a continuing HIV-1 epidemic, which has an influence on HPV pathogenesis and viral loads of certain HR-HPVs. We hypothesize that the distribution of HR- and LR-HPV genotypes differs between urban areas, where HIV prevalence is higher, and rural areas where HIV burden is lower. This could be due to more prevalent HR-HPV genotypes or the skewing of HR-HPV genotypes in populations with higher HIV incidence. It is also possible that enhanced HR-HPV viral load due to HIV and immunosuppression enhances the likelihood of HR-HPV transmission In populations. Thus, the aims of this project are to: Specific Aim 1. Determine the effects of HIV on HPV genotype distribution and viral load in rural and urban populations. Specific Aim 2. Characterize the epidemiological and reproductive factors that predict distribution, transmission, and progression of HPV and related diseases through a risk assessment analysis. A better understanding of relationships between HIV and HPV genotype distribution and transmission will better inform Tanzanian public health decisions about how to most effectively implement limited HR-HPV detection and prevention resources to reduce the most prevalent malignancy in women.